The State of Illinois has selected its Essential Health Benefits benchmark plan - the Blue Cross Blue Shield of Illinois BlueAdvantage Entrepreneur plan.
This plan sets the bar for 10 categories of health care benefits (called "Essential Health Benefits" by the Affordable Care Act), and all non-grandfathered individual and small group health plans sold in Illinois must measure up to this plan in "actuarial value." Actuarial value is an estimate of the overall financial protection provided by a health plan. (For a great explanation of Actuarial Value, check out this recent Consumers' Union report).
The Blue Cross Blue Shield of Illinois BlueAdvantage Entrepreneur plan is the largest small group plan in Illinois, making it the default plan if Illinois failed to select a plan, as stated in the Affordable Care Act. According to this Illinois Department of Insurance report, the plan was the third leanest plan out of the 10 options considered. It is a PPO and it covers all of the services that Illinois law mandates, such as treatment for autism and infertility. But it doesn't cover extra services such as massage or acupuncture. The plan is supplemented by All Kids for pediatric dental and the Federal Vision Insurance Plan for children’s vision.
We have been following the establishment of an EHB benchmark in the state closely; you can read up on the EHB selection process in Illinois here and here.
Friday, 25 January 2013
Thursday, 24 January 2013
Illinois Medicaid Redetermination -- What It is & What To Tell Your Clients
In 2012, the Illinois Legislature passed the Save Medicaid and Resources Together (SMART) Act. One portion of this Act aimed to address the backlog of Medicaid redeterminations that has accumulated over the years. From this Act came the 'Illinois Medicaid Redetermination Project' (ILRP), more informally known as "Enhanced Eligibility Verification" (EEV).
The goal of EEV is to determine the eligibility status of current Medicaid recipients and adjust or eliminate benefits accordingly. This will be the system that redetermines Medicaid eligibility annually for current and newly enrolled recipients. The circumstances under which individuals may be removed from Medicaid include death, relocation out of state, or excess income, amongst many others.
The State has contracted with MAXIMUS Health Services Inc. and developed a case review system that categorizes Medicaid cases as those most likely eligible and those potentially ineligible for medical services. To this end, MAXIMUS has begun its operation and as early as this week will be reaching out to current Medicaid recipients who they believe are no longer eligible for Medicaid benefits.
As early as this week, these enrollees will receive a letter in the mail from the Illinois Medicaid Redetermination Project requesting they submit the appropriate eligibility verification documents.
PLEASE NOTE:
If Medicaid enrollees fail to provide the proper documentation after receiving a letter of notice in the mail, their file will also be sent back to a case manager and their benefits likely eliminated. Although the state has implemented a new system to redetermine Medicaid eligibility, the appeal rights of applicants remains intact.
As Medicaid enrollees will only have 10 business days to submit the required verifying documentation, it's extremely important that advocates and providers provide support to their participants who receive Medicaid benefits that may need to submit such additional documents. With such a short turn-around time and in order to ensure continuity of care, it's imperative that Medicaid enrollees understand what they must provide and submit that information within the allotted time frame.
Contact information for the Illinois Medicaid Redetermination Project can be found below and summary of the program can be found here.
Illinois Medicaid Redetermination Program Hotline Information
Hours of Operation: Monday - Friday, 7:00 am - 9:00 pm, Central Time
Saturday, 8:00 am - 1:00 pm, Central Time
Phone Number: 1-855-HLTHYIL (1-855-458-4945)
TTY: 1-855-694-5458
Mailing Address: Illinois Medicaid Redetermination, PO Box 1242, Chicago, IL 60690-9992
FAX: 1-855-394-8066
Nadeen Israel & Molly McAndrew
Heartland Alliance for Human Needs & Human Rights
The goal of EEV is to determine the eligibility status of current Medicaid recipients and adjust or eliminate benefits accordingly. This will be the system that redetermines Medicaid eligibility annually for current and newly enrolled recipients. The circumstances under which individuals may be removed from Medicaid include death, relocation out of state, or excess income, amongst many others.
The State has contracted with MAXIMUS Health Services Inc. and developed a case review system that categorizes Medicaid cases as those most likely eligible and those potentially ineligible for medical services. To this end, MAXIMUS has begun its operation and as early as this week will be reaching out to current Medicaid recipients who they believe are no longer eligible for Medicaid benefits.
As early as this week, these enrollees will receive a letter in the mail from the Illinois Medicaid Redetermination Project requesting they submit the appropriate eligibility verification documents.
PLEASE NOTE:
- The envelope that the redetermination letter will arrive in is non-descript with nothing distinguishing it from junk mail. Advocates have made HFS aware of this issue and they have said they will be changing it.
- Current Medicaid enrollees will have only 10 business days to submit the proper eligibility verifying documents.
If Medicaid enrollees fail to provide the proper documentation after receiving a letter of notice in the mail, their file will also be sent back to a case manager and their benefits likely eliminated. Although the state has implemented a new system to redetermine Medicaid eligibility, the appeal rights of applicants remains intact.
As Medicaid enrollees will only have 10 business days to submit the required verifying documentation, it's extremely important that advocates and providers provide support to their participants who receive Medicaid benefits that may need to submit such additional documents. With such a short turn-around time and in order to ensure continuity of care, it's imperative that Medicaid enrollees understand what they must provide and submit that information within the allotted time frame.
Contact information for the Illinois Medicaid Redetermination Project can be found below and summary of the program can be found here.
Illinois Medicaid Redetermination Program Hotline Information
Hours of Operation: Monday - Friday, 7:00 am - 9:00 pm, Central Time
Saturday, 8:00 am - 1:00 pm, Central Time
Phone Number: 1-855-HLTHYIL (1-855-458-4945)
TTY: 1-855-694-5458
Mailing Address: Illinois Medicaid Redetermination, PO Box 1242, Chicago, IL 60690-9992
FAX: 1-855-394-8066
Nadeen Israel & Molly McAndrew
Heartland Alliance for Human Needs & Human Rights
Friday, 18 January 2013
What is the Illinois Partnership Health Insurance Marketplace?
The Affordable Care Act requires each state to have a health insurance marketplace (otherwise known as a "health insurance exchange"). Originally, the plan was for each state to establish its own health insurance marketplace, or default to a federally-run exchange. After the ACA passed, the federal government offered a new “partnership exchange” model, which is to relieve some of the administrative burden on the state by providing federal assistance. Illinois sent the federal government a blueprint application in November 2012 to establish a state-federal partnership exchange in 2014, with plan to transition to a state based exchange after 2015. The state is waiting for final approval of the blueprint.
On January 3, 2013, the federal Center for Consumer Information and Insurance Oversight sent out guidance on how a partnership health insurance exchange will work. The guidance allows states like Illinois who plan to transition to a state based exchange to take on as much responsibility as possible for exchange activities such as administration, plan selection, and consumer assistance. This model is referred to as a State Plan Management Partnership Exchange.
A key role of a state exchange is to provide consumers assistance in enrolling in the exchange, understand their options for insurance coverage, make decisions about coverage, and coordinate with community based organizations. This consumer help will be provided by two programs, In-Person Assisters (IPA) and Navigators, which will be separate but closely coordinated. The Navigator program will be run by the Federal government, and Illinois will develop the IPA program. Since Illinois has historic connections in the community and their understanding of the state-specific insurance, Medicaid and supplemental state health programs, the IPA program will be the primary contact for consumers and for insurance companies.
Community Based Organizations, consumer assistance organizations, medical and social service providers will all play an important role in ensuring that the Illinois state federal partnership exchange is efficient and accessible. Consumer advocates should work cooperatively with the state and federal governments to ensure that whichever agencies are responsible for administering parts of the exchange, that the end result is a coordinated system that works well for the people who need insurance coverage, including the small employers who need to purchase insurance for their employees.
Stephanie Altman
Programs & Policy Director
Health & Disability Advocates
On January 3, 2013, the federal Center for Consumer Information and Insurance Oversight sent out guidance on how a partnership health insurance exchange will work. The guidance allows states like Illinois who plan to transition to a state based exchange to take on as much responsibility as possible for exchange activities such as administration, plan selection, and consumer assistance. This model is referred to as a State Plan Management Partnership Exchange.
A key role of a state exchange is to provide consumers assistance in enrolling in the exchange, understand their options for insurance coverage, make decisions about coverage, and coordinate with community based organizations. This consumer help will be provided by two programs, In-Person Assisters (IPA) and Navigators, which will be separate but closely coordinated. The Navigator program will be run by the Federal government, and Illinois will develop the IPA program. Since Illinois has historic connections in the community and their understanding of the state-specific insurance, Medicaid and supplemental state health programs, the IPA program will be the primary contact for consumers and for insurance companies.
Community Based Organizations, consumer assistance organizations, medical and social service providers will all play an important role in ensuring that the Illinois state federal partnership exchange is efficient and accessible. Consumer advocates should work cooperatively with the state and federal governments to ensure that whichever agencies are responsible for administering parts of the exchange, that the end result is a coordinated system that works well for the people who need insurance coverage, including the small employers who need to purchase insurance for their employees.
Stephanie Altman
Programs & Policy Director
Health & Disability Advocates
Wednesday, 9 January 2013
A New Year and New Medicaid Awaits Us
What an amazing and historic beginning to the start of 2013. This week an Illinois legislative body advanced a major piece of the Affordable Care Act (ACA), when the House Human Services Appropriation Committee passed HB 6253, Medicaid Financing for the Uninsured.
After the committee vote, the waning hours of the current term of the General Assembly did not provide enough time to advance the bill further. Nevertheless, our momentum continues with renewed commitment and excitement.
This effort brought together an unusual mixture of health care providers, business interests, patients and advocates, demonstrating as great a degree of consensus on an issue like this as you are likely ever to find. We know it is right and advantageous for Illinois to accept new federal Medicaid funding, fill a historic gap in the Medicaid program and provide health care coverage for hundreds of thousands of the lowest income uninsured Illinois residents.
The fight continues and we have laid the scaffolding for us to build upon as we enter the 98th General Assembly today. Illinois House and Senate members will file new Medicaid bills, and once the new General Assembly begins, your voices will need to be heard again with in-district meetings, emails and phone calls to your Senators and Representatives, many of whom will be new in office or serving from redrawn districts. It will be critical that these legislators hear from you.
Thank you for all you have done. And thank you, in advance, for all the help you will provide in helping to achieve federal Medicaid funding for the uninsured in Illinois.
Ramon Gardenhire
Director of Government Relations
AIDS Foundation of Chicago
Monday, 7 January 2013
Start Your Week Right! Contact Springfield Today.
Leveraging Federal Financing for the Uninsured (HB 6253) Reaches the Illinois House THIS WEEK!
In Illinois today, thousands of low-income adults without dependent children are not eligible for Medicaid. This major gap in healthcare coverage would be eliminated by HB 6253 under the ACA. This Medicaid option is expected to bring $4.6 billion additional federal dollars into the state of Illinois just in the first three years, making it a great fiscal deal for Illinois!
HB 6253 authorizes Illinois to take advantage of the ACA to provide Medicaid to about 342,000 low-income Illinois citizens who are currently uninsured. Because of the ACA, Illinois can offer Medicaid to this population at no expense to the state for the first three years, and in later years the state will never pay more than 10% of the cost of this coverage (with federal funds covering the remaining 90%). Learn more about HB 6253 HA1.
2 Ways to Take Action TODAY:
- Tell your Illinois Representative to support HB 6253 today! Call the easy and toll-free ‘Illinois Affordable Health Care Hotline’ 1-888-616-3322 to be connected to your legislator. Need some talking points? Click here. You can also look up your Illinois Representative’s contact information directly using this easy online tool! Click here.
- Submit an electronic witness slip in favor of the bill: You can click here to file an electronic witness slip today. Click on the icon on the right of the Appropriations committee to find the listing for HB 6253. Once you find HB 6253, click on “Create Witness Slip.” You should check the “proponent” box for House Amendment #1 (HA #1) and the “Record of Appearance Only” box.
*The 'Illinois Affordable Health Care Hotline’ is a function of the AARP Hotline. Please, do not be alarmed by the AARP phone recording. This phone line is open to everyone.
*The original House bill number (HB 5019) has changed since the recording of the Hotline to HB 6253, and may change again! Please, do not be alarmed by the incorrect bill number. This phone line is still active to support 'Medicaid Financing for the Uninsured'.
Thank you!
Questions? Contact Stephani Becker (312.265.9072) or Stephanie Altman (312.265.9070) at HDA.
Wednesday, 19 December 2012
Advanced Practice Nurses: Willing to Meet the Needs of the Medicaid Expansion
This guest post was written by Donna Petko, MSN(c), BSN, RN; Clinical Director; 1st Choice Home Health Providers, LLC
If Medicaid Eligibility Expansion (HB 6253) is approved in early January 2013, an estimated 342,000 low-income adults in Illinois will become eligible and enrolled in Medicaid over the next four years. Once these individuals become insured, they are likely to seek out primary care providers. However, as designated by the United States Department of Health and Human Services, 100 counties in Illinois have been identified as having State Physician and/or Federal Health Professional Shortage areas (Health & Medicine Policy Research Group [HMPRG], 2012). Who will provide primary health care services to these newly enrolled Illinois residents?
Advanced practice nurses (APNs) are one solution to the growing shortage of primary care physicians (PEW, 1999). APNs are registered nurses who have advanced knowledge and clinical training, a graduate degree, and hold national certification. These professionals serve as health care providers in a broad range of primary care, acute care, and outpatient settings. In Illinois, there are four categories of APNs: certified nurse-midwife (CNM), clinical nurse specialist (CNS), certified nurse practitioner, (CNP) and certified registered nurse anesthetist (CRNA). Currently, there are more than 7,500 advanced practice nurses in the state of Illinois (HMPRG, 2012).
What do advanced practice nurses do? APNs diagnose illnesses, prescribe treatments and medications, and provide primary care services in a variety of settings which include hospitals, clinics, community health centers, nursing facilities, and schools (HMPRG, 2012). According to the Institute of Medicine (IOM) report The Future of Nursing: Leading Change, Advancing Health (2010), APNs increase patient safety, access, and continuity of care. Data from studies on APNs show that these professionals deliver safe, high-quality primary care services (ANA, 2012).
In order to meet the growing need for healthcare services within the state, APNs need to practice to the fullest extent of their education and training. How do we increase access to healthcare services for Illinois residents? By changing the Nurse Practice Act and removing practice barriers:
- Eliminating the requirement for a written collaborative agreement between physicians and APNs
- Allowing APNs to participate in the insurance exchange as primary care providers
- Providing APNs with full plenary authority to provide access to Illinois residents needing primary care services (HMPRG, 2012).
Besides providing safe, high-quality healthcare, APNs provide a considerable cost savings as well. For example, the average cost of a nurse practitioner (NP) visit is between 20-35% less than the average cost of an office-based physician visit (Medical Expenditure Panel Survey, 2010). Furthermore, malpractice rates of NPs are no higher in states with independent NP practice when compared to those states where collaboration is required for practice (HMPRG, 2012).
In addition to supporting HB 6253, which will allow Illinois to leverage over $5 billion in federal Medicaid funding to provide comprehensive health care coverage to over 342,000 low-income individuals (Becker, 2012), please support advanced practice nurses in their quest to provide better access to healthcare services for Illinois residents. Because APNs are more likely to work in underserved areas caring for Medicaid beneficiaries than primary care physicians (Grumbach et al., 2003; Kaiser, 2011), the barriers to practice must be removed.
The Illinois General Assembly needs to pass HB 6253 by January 9, 2013, the end of the current legislative session, to ensure programs and systems are in place just 12 months from now, when one of the largest parts of health care reform begins (IHM, 2012). Once this bill is passed, the only way to ensure better access to care for Illinois residents is by changing the Nurse Practice Act to allow APNs to practice to the fullest extent of their education and training.
Please continue to support this common-sense, fiscally sound legislation in Illinois. To find out who your legislators are, go to the Illinois State Board of Elections Search Page. Please share this message and urge your friends and family members to tell their legislators to support these efforts between now and January 9, 2013. For more info, read this fact sheet from Health & Medicine Policy Research Group.
Tuesday, 18 December 2012
What Happens to the Pre-Existing Condition Plans on Jan. 1, 2014?
This post is the first in a series on the Illinois State Partnership Exchange Blueprint Application, which is pending approval by the Federal Government.
For years, health insurance carriers refused to sell coverage to individuals with pre-existing medical conditions. The Affordable Care Act (ACA) created federally funded high risk pools across the country, including the Illinois Pre-Existing Condition Insurance Plan (IPXP) so that people denied for that reason would not have to go without health insurance. Starting on January 1, 2014, the ACA bans insurance companies from denying coverage based on pre-existing conditions. As a result, IPXP will no longer be needed, and coverage under the plan will be terminated.
So what happens to the enrollees of IPXP on January 1, 2014?
The ACA dictates that anyone currently enrolled in IPXP will be transitioned into a private insurance plan via the state health insurance exchange. This transition process will happen at the end of 2013. According to the Illinois State Partnership Exchange Blueprint Application, the state has mechanisms in place to prevent lapses in health coverage, as follows:
IPXP will only extend coverage for health services until December 31, 2013, which means that all current IPXP enrollees will need to find an alternative health plan before January 1, 2014. Claims dating from before December 31, 2013 will need to be filed in the close-out period, which will run until June 30, 2015. If deferral funding for the IPXP program has run out, however, even claims filed before that date will not be payable.
Open enrollment into the state health insurance exchange will begin on October 1, 2013, with insurance coverage beginning on January 1, 2014. If current IPXP enrollees purchase a plan during open enrollment, there should be no gaps in their health coverage. Since Illinois is still in the process of establishing its health insurance exchange, check back here for details on how and where to enroll in a health insurance exchange plan, as well as future updates on the IPXP transition process. If you have questions now, contact IPXP at (877) 210-9167, or e-mail your question directly to IPXPInquiry@healthalliance.org
For years, health insurance carriers refused to sell coverage to individuals with pre-existing medical conditions. The Affordable Care Act (ACA) created federally funded high risk pools across the country, including the Illinois Pre-Existing Condition Insurance Plan (IPXP) so that people denied for that reason would not have to go without health insurance. Starting on January 1, 2014, the ACA bans insurance companies from denying coverage based on pre-existing conditions. As a result, IPXP will no longer be needed, and coverage under the plan will be terminated.
So what happens to the enrollees of IPXP on January 1, 2014?
The ACA dictates that anyone currently enrolled in IPXP will be transitioned into a private insurance plan via the state health insurance exchange. This transition process will happen at the end of 2013. According to the Illinois State Partnership Exchange Blueprint Application, the state has mechanisms in place to prevent lapses in health coverage, as follows:
- Illinois will send at least three letters to IPXP enrollees containing information on the transition process;
- The state will conduct proactive outreach to IPXP participants and update the IPXP website with relevant information; and
- The Illinois health insurance exchange will have extra personnel at the call center specifically to assist with the IPXP transition.
IPXP will only extend coverage for health services until December 31, 2013, which means that all current IPXP enrollees will need to find an alternative health plan before January 1, 2014. Claims dating from before December 31, 2013 will need to be filed in the close-out period, which will run until June 30, 2015. If deferral funding for the IPXP program has run out, however, even claims filed before that date will not be payable.
Open enrollment into the state health insurance exchange will begin on October 1, 2013, with insurance coverage beginning on January 1, 2014. If current IPXP enrollees purchase a plan during open enrollment, there should be no gaps in their health coverage. Since Illinois is still in the process of establishing its health insurance exchange, check back here for details on how and where to enroll in a health insurance exchange plan, as well as future updates on the IPXP transition process. If you have questions now, contact IPXP at (877) 210-9167, or e-mail your question directly to IPXPInquiry@healthalliance.org
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